Generalized pustular psoriasis, Clinical study, Psoriasis

Youn, Jai Il; Oh, Jun Gyu

Abstract

BACKGROUND: Generalized pustular psoriasis(GPP) is an uncommon from of psoriasis in which a widespread eruption of sterile oustules occurs. In Korea some cases of generalized pustular psoriasis have been reported, but clinical reviews on generalized pustular psoriasis are not available.
OBJECTIVE
We investegated the clinical and laboratory findings in some patients with generalized pustular psoriasis in Korea.
METHODS
We studied the clinical and laboratory findings in 27 patients with generalized pustular psoriasis who visited Seoul National University hospital during the past 10 years. All the data were analyzed in total of patients with generalized pustular psoriasis, and analyzed after the patients were separated into 4 clinical types.
RESULTS
1. The male to female ratio was 1:2, and the average age of the first onset of GPP was 27.1 years. 2. The number of patients with previous history of psoriasis vulgaris were 19(70.4%). In these patients, the average age at the onset of psoriasis vulgaris was 23.4 years, and average age at the onset of GPP was 34.3 years. 3. The number of patients with a family history of psoriasis were 2(7.4%) 4. The number of patients with possible provocative factors were 16(59.3%). Systemic corticosteroid therapy was done before the onset of GPP in 7 patients, and was the most common provocative factor. 5. Fever(70.4%), chill(33.3%), and arthralgia(18.5%) were common systemic symptoms associated with GPP. 6. In laboratory tests, leukocytosis(63%), elevated ESR(62.5%), hypoalbuminemia(40.7%), and decreased cortisol(32.5%) were often found. 7. With the clinical types, the acute generalized type was 59.3%, juvenile and infantile type 25. 9%, annular and circinate type 7.4%, and GPP during pregnancy was 7.4%. In juvenile and in fantile type, patients with a previous history of psoriasis vulgaris and possible provocative factors of GPP were much less common than in the other types.
CONCLUSION
In patients with GPP in Korea, a family history of psoriasis is much less frequent than in western countries. In the possible provocative factors of GPP, systemic corticosteroid therapy was the most common, so it is recommended that systemic steroid therapy should be avoided in the treatment of psoriasis vulgaris. In the comparison of the 4 clinical types, juvenile and infantile type showed a marked iifference in that GPP occurred spontaneously without any previous history of psoriasis and with no provocative factors.